Private printable worksheet
Compare Medicare options beyond the monthly premium
Use this worksheet while reviewing official plan materials or Medicare Plan Compare. Entries stay on this page unless you print or save them yourself.
Coverage path
| Comparison item | Option A | Option B | Option C |
|---|---|---|---|
| Original Medicare with separate choices | |||
| Medicare Advantage plan | |||
| Medicare Supplement policy plus Part D |
Providers and access
| Comparison item | Option A | Option B | Option C |
|---|---|---|---|
| Primary doctor and specialists checked | |||
| Preferred hospitals and facilities checked | |||
| Referral and network rules understood | |||
| Travel or multi-state care needs reviewed |
Prescriptions
| Comparison item | Option A | Option B | Option C |
|---|---|---|---|
| Every prescription and dosage entered | |||
| Formulary status and restrictions checked | |||
| Preferred pharmacies checked | |||
| Estimated annual drug cost reviewed |
Costs and tradeoffs
| Comparison item | Option A | Option B | Option C |
|---|---|---|---|
| Monthly premiums | |||
| Deductibles and common copays | |||
| Maximum out-of-pocket exposure when applicable | |||
| Expected total yearly cost, not premium alone |
Do not enter a Medicare number, Social Security number, financial account number, or other sensitive identifier.
Official sources
Verified 2026-07-21; scheduled for review by 2026-09-15. Use Medicare.gov for the official decision or amount.
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